Controlled Drug E-Prescriptions: Policy Versus Practice

"Hello, Dr. Fisher?"

"Yes, this is Dr. Fisher"

"This is Sam Smart, pharmacist at Walgreens over in East Elsewhere."

"Yes, sir, how can I help you?"

"Well it's about that prescription you gave to Mr. Pacertoday for Norco."

"What about it?"

"Well, it's not printed on the right controlled drug presciption paper."

"But that's how we've been issuing prescriptions. I haven't seen any of that special printer paper with that squiggly-lined paper for months. I know we're 'sposed to use in that kind of paper, but it's never in the printer and there's no special printer for controlled drugs, so we just use regular paper. It has my signature, right?"

"Well, there's a signature, but I really can't tell if this is an authorized signature without the proper paper..."

"But you're talking to me, right?"

"Uh, yeah."

"And you called my office phone number, right?"

"Uh, yeah."

"So can you fill the prescription now that you've verified that I'm the one who wrote the prescription?"

"Well, I'm really not supposed... Well, I will this time. But in the future, make sure you use the right paper, okay?"

No, not okay.

Doctors, nurses, and secretaries do not have time to fill special paper in printers to write prescriptions for controlled drugs, yet this is what our fabulous regulators require in order to prevent Medicare fraud. Practically speaking, this isn't happening for the simple fact that it's impractical.

How about just allowing us to send our controlled drug script electronically, like all of the other prescriptions we send? Or maybe add an encoded PIN number?

Using fully implemented e-prescribing would likely have much less potential for fraud and abuse...

..unless, of course, our electronic medical record systems aren't as secure as the bureaucrats say they are.

-Wes

Reference: "Frequenty Asked Questions Concerning the Tamper-Resistant Prescription Law (Section 7002(b) of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act OF 2007), Center for Medicare and Medicaid Services.

The Wonders of Electronics

E-prescribing.

The envy of Washington.

The envy of IT departments.

But occassionly, the scourge of doctors and patients.

Why?

No paper trail. No proof. Just lost electrons when a prescription fails to go through.

When it works, it's great: a script flies at the speed of light (literally) to a local pharmacy near you. One set up to receive the little electrons and it pops up on Mr. Pharmacist's work cue. Presto!

But when it fails, doctors become the impotent bad guys:

"Hey doc, you never sent my script."

"Uh, yes, Mr. Jones, I did. I sent it to YourLocalPharmacy in YourTown yesterday. I even have the order number."

"Doc, I was at YourLocalPharmacy and he said you never sent it. He didn't have any scripts with my name. Nothing. Nada. You sure you sent it off?"

"Yes, Mr. Jones, I'm looking at the order right now. I never received an e-mail that it failed to deliver, like it's supposed to if that happens, but I'll call the Pharmacist at YourLocalPharmacy in YourTown and find out what's up."

"Thanks, Doc."

* brrriinnnnggggg bbbbrrrriinngggg *

* Click *

"Hello. Welcome to YourLocalPharmacy where you can get all your meds at a moments notice! If you're a calling about a new prescription, press 1. If you're a doctor or a doctor's office calling, press 2..."

*2*

"Just a moment please..." ("Tie a yellow ribbon 'round the old oak tree" plays in the background...)

"This is Sally the pharmacy assistant, may I help you?"

"Yes Sally, this is Doctor Fisher and I'm inquiring about a prescription on Mr. SomeDude that I wrote as an e-prescription yesterday for 10 mg tablets of Wonderdrug, and he says you never received it..."

"Just a moment, doctor..."

(... it's been two long years, will you still want me...)

"This is Joe the Pharmacist..."

"Yes, Joe, this is Doctor Fisher and I'm calling about my prescription on Mr. SomeDude that I sent yesterday as an e-prescription for 10 mg tablets of Wonderdrug and he was told you never received it..."

"What was the last name?"

"SomeDude..."

"One second..."

(...stay on the bus, forget about us, put the blame on meeeee...)

"I'm sorry, we don't have anything for a Mr. SomeDude here at our pharmacy..."

"Would you like the order confirmation number that I have on my handy dandy EMR screen that says it was sent to you yesterday about 12:45 PM - yep, sent to YourLocalPharmacy in YourTown on 3 April."

"We don't use order numbers here... Wait, let me check one other place. One second..."

"Now the whole damn bus is cheering, and I can't believe I seeeee, a hundred yellow ribbons round the ole oak tree..."

"Hello, Dr. Fisher?"

"Yes?"

"We don't have any scripts here for Mr. SomeDude. I checked both our systems and don't see anything for him here.... Maybe our staff hit a delete key or something. Sometimes that happens you know. I just don't see it... What did you want to give him again? I'll just take the verbal and have it ready for him..."

"Its for sixty 10-milligram pills of WonderDrug with two refills. The sig is one to two tablets every six hours as needed for what he really needs it for."

"Okay, I'll have it ready for him..."

I sat and looked at the order verification screen before me. Wonderdrug. 10mg tablets. YourLocalPharmacy in YourTown. E-Script. Order confirmation number. All correct. Seemingly sent.

And yet, nothing. Vapor. Into the electronic ether. I felt like the the young apprentice sitting before the zen master:

Apprentice: "Master, if a tree falls in the forest and no one hears it, does it make a sound?"

Zen Master: "No, Grasshopper... but the squirrel it lands on does."

-Wes